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Associations Between Kidney Disease Measures and Regional Pulse Wave Velocity in a Large Community-Based Cohort: The Atherosclerosis Risk in Communities (ARIC) Study.

TitleAssociations Between Kidney Disease Measures and Regional Pulse Wave Velocity in a Large Community-Based Cohort: The Atherosclerosis Risk in Communities (ARIC) Study.
Publication TypeJournal Article
Year of Publication2018
AuthorsKim ED, Tanaka H, Ballew SH, Sang Y, Heiss G, Coresh JJ
Secondary AuthorsMatsushita K
JournalAm J Kidney Dis
Volume72
Issue5
Pagination682-690
Date Published2018 11
ISSN1523-6838
KeywordsAge Distribution, Aged, Aged, 80 and over, Albuminuria, Ankle Brachial Index, Atherosclerosis, Cardiovascular Diseases, Creatinine, Cross-Sectional Studies, Disease Progression, Female, Glomerular Filtration Rate, Humans, Incidence, Independent Living, Male, Prognosis, Pulse Wave Analysis, Renal Insufficiency, Chronic, Risk Assessment, Sex Distribution, Survival Analysis, United States, Vascular Stiffness
Abstract

RATIONALE & OBJECTIVE: Arterial stiffness is suggested as a mediator of cardiorenal interaction. However, previous studies reported inconsistent associations between chronic kidney disease (CKD) and arterial stiffness and were limited by using either estimated glomerular filtration rate (eGFR) or albumin-creatinine ratio (ACR) and examining arterial stiffness at limited segments.

STUDY DESIGN: Cross-sectional.

SETTING & PARTICIPANTS: 3,424 Atherosclerosis in Communities (ARIC) Study participants aged 66 to 90 years during 2011 to 2013.

PREDICTORS: eGFR and ACR.

OUTCOME: Pulse wave velocity (PWV) at 6 segments: carotid-femoral (cfPWV), heart-carotid (hcPWV), and heart-femoral (hfPWV), reflecting central stiffness; heart-ankle (haPWV) and brachial-ankle (baPWV), representing both central and peripheral stiffness; and femoral-ankle (faPWV), indicating peripheral stiffness.

ANALYTICAL APPROACH: Multiple linear and logistic regression models to quantify the associations of eGFR and ACR with continuous PWV and elevated PWV (in the highest quartile), respectively.

RESULTS: After adjusting for age, sex, and race, higher cfPWV and hfPWV were consistently associated with lower eGFR and higher ACR. Higher haPWV and baPWV were also observed with higher ACR. The independent association of both CKD measures with elevated cfPWV remained consistent after adjusting for additional confounders (ORs of elevated cfPWV were 1.09 [95% CI, 1.01-1.18] per 15-mL/min/1.73m lower eGFR and 1.20 [95% CI, 1.07-1.33] per 4-fold higher ACR). Higher ACR was also associated with elevated hfPWV and haPWV (ORs per 4-fold higher ACR were 1.25 [95% CI, 1.12-1.39] for elevated hfPWV and 1.19 [95% CI, 1.06-1.33] for elevated haPWV). Lower eGFR was associated with lower odds of elevated baPWV and faPWV (ORs per 15-mL/min/1.73m lower eGFR were 0.92 [95% CI, 0.84-0.99] and 0.91 [95% CI, 0.85-0.99], respectively).

LIMITATION: Unable to address temporality between CKD measures and arterial stiffness.

CONCLUSIONS: Both lower eGFR and higher ACR are independently associated with measures of central arterial stiffness, with stronger associations for ACR over eGFR. Our findings suggest that central arterial stiffness may be an important pathophysiologic phenotype of vascular disease in CKD.

DOI10.1053/j.ajkd.2018.04.018
Alternate JournalAm J Kidney Dis
PubMed ID30007506
Grant ListHHSN268201100006C / HL / NHLBI NIH HHS / United States
HHSN268201100007C / HL / NHLBI NIH HHS / United States
HHSN268201100005C / HL / NHLBI NIH HHS / United States
HHSN268201100008C / HL / NHLBI NIH HHS / United States
HHSN268201100009C / HL / NHLBI NIH HHS / United States
HHSN268201100010C / HL / NHLBI NIH HHS / United States
HHSN268201100011C / HL / NHLBI NIH HHS / United States
HHSN268201100012C / HL / NHLBI NIH HHS / United States